Controversial Aspects of the Prehospital Trauma Care

Despite decades of studies and experiences, an evidence-based medicine consensus on the more appropriate treatment of trauma patients in the out-of-hospital setting has not yet been achieved. Different approaches exist and no one has been demonstrated clearly superior over the others for all the circumstances and for all patients. A number of factors likely account for this finding. First, just as the very concept of airway-breath-circulation indicates the goals of a treatment and not the treatment by itself, the different levels of training and expertise of professionals trying to achieve it can be associated with different outcomes. Second, the most appropriate approach differs in patients with penetrating or blunt injuries. Third, similar to what has been hypothesized in other fields of critical care medicine, perhaps the mortality rate is a rather rough, albeit unequivocal, marker of either outcome or appropriateness of care, and should be substituted with other indexes, including changes of some biologic variables or the quality of life of survivors. Finally, and most important, the on-scene treatment is the critical link between the out-of-hospital chain-of-survival and the in-hospital system of delivery of care, and weak points of either system can influence the outcome independently from the others. © 2006 Elsevier Inc. All rights reserved.